A swift and collaborative international response could have stopped the 2019 Covid-19 outbreak in China becoming a global catastrophe in 2020, according to a scathing report on the response of world leaders and the World Health Organization to the pandemic.
An expert review by the Independent Panel for Pandemic Preparedness and Response, commissioned by the WHO, sets out lessons for preventing future pandemics and makes dozens of recommendations for reform.
They include a new treaty setting up a Global Health Threats Council, more surveillance power for the WHO to investigate and publish information about disease outbreaks without the approval of governments, and new funding for an International Pandemic Financing Facility (IPFF) that could spend $5bn-$10bn a year on preparedness and call on $50bn-$100bn at short notice in a health emergency.
“The panel is recommending a fundamental transformation designed to ensure commitment at the highest level to a new system . . . on which citizens can rely to keep them safe and healthy,” said its co-chairs, former New Zealand prime minister Helen Clark and former president of Liberia Ellen Johnson Sirleaf.
The review does not examine the origins of Sars-Cov-2, the virus that causes Covid-19. But it criticises the Chinese authorities and WHO for being too slow to recognise that the virus was spreading between people in Wuhan and then to warn the world about human to human transmission.
“For the future, a precautionary approach should be used from the outset, acknowledging that a respiratory disease may spread from person to person unless and until established otherwise,” the report says.
The panel is scathing about the International Health Regulations, the only legally binding instrument on disease outbreaks. “As currently constructed [they] serve to constrain rather than facilitate rapid action,” the report says. “With respect to travel, it is hard to see that the IHR’s discouragement of restrictions is realistic for pandemics in our highly interconnected age.”
“If travel restrictions had been imposed more quickly and more widely, that would have been a serious inhibition on the rapid transmission of the virus,” Clark told a press briefing ahead of the review’s publication. “We have to realise that we are living in the 21st century and not in medieval times.”
The panel criticises the WHO for not declaring Covid a public health emergency of international concern until January 30. It was officially called a pandemic on March 11.
But the strongest criticism was directed at the wealthy nations of Europe and North America for “wasting February 2020” through inaction — leading to “a lost month when many more countries could have taken steps to contain the spread of Sars-Cov-2 and forestall the global health, social and economic catastrophe that continues its grip”.
When the gravity of the crisis was finally acknowledged in March 2020, “there was a mad scramble for PPE, therapeutics and other equipment”, said Clark. “This was compounded by a lack of global leadership.”
To provide leadership in future, the panel calls on the world’s heads of government to set up a Global Health Threats Council and a Pandemic Framework Convention to provide a stronger legal foundation for action. It recommends these are launched at a global summit, a special session of the United Nations General Assembly that should be convened for the purpose later this year.
The council would allocate funds from the IPFF to institutions developing preparedness and response capabilities, including a global platform capable of delivering vaccines, diagnostics, drugs and supplies “swiftly and equitably worldwide — shifting from a market model to one aimed at delivering global public goods”. The facility should be ready to disburse up to $100bn at short notice in the event of another pandemic, the panel says.
The review also calls for the authority and financing of the WHO to be strengthened. This would involve increasing the fees paid by member states; “depoliticising recruitment (especially at senior levels) by adhering to criteria of merit and relevant competencies”; improving the performance of its board — which the panel says failed to perform as an executive body during the pandemic — and appointing a director-general with a single seven-year term of office rather than the current renewable five-year terms.
Panel members are talking to heads of government to ensure the measures are implemented. “The shelves of storage rooms in the UN and national capitals are full of reports and reviews of previous health crises,” Sirleaf said. “Had their warnings been heeded, we would have avoided the catastrophe we are in today. This time must be different.”